Restructure ACO model so it's less punitive, more flexible; and other letters

The recent article “Two more Pioneer ACOs exit as new CMS model emerges” raises good questions about why half of the original 32 Pioneer accountable care organizations have dropped out of the program. Arguably the highest-quality and lowest-cost Pioneer based on 2014 CMS data, Bellin-ThedaCare Healthcare Partners, struggles with many of the same issues.

We, along with some of our colleagues, have studied and written extensively about why the Pioneer ACO program isn't working, and how it could be restructured. As noted in the article, future savings are not only more difficult to achieve, but financially punitive for organizations that are already extremely effective at delivering high-value care to patients.

Some of the adjustments we suggest, based on years of experience in the program, include: risk-, geographic- and outcomes-adjusted payments; patient attribution that is also flexible to allow for patient mobility; and aligned patient benefits. For more detail on how the next generation ACO program could be restructured, read our blog post at ow.ly/UOBtQ.

We are hopeful and encouraged that the CMS is open to exploring what “better” looks like according to those closest to the work.

Dr. John Toussaint

Dr. David Krueger

Regarding the recent article “Maryland hospitals show cost, quality improvement under revamped payment model,” I think the point is to help patients transition home safely and effectively so they are able to manage their conditions.

The terminology “keep the patient out of the hospital” is negative. Patients will be readmitted, especially when their conditions are progressive and complex. We expect patients and caregivers to do too much with little support, resources and education. Until we address these shortfalls, the problem will continue.

Anne Llewellyn